The high cost of unnecessary care

May 11, 2021
Lindsey Logan

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It’s important to health cost sharing organizations to keep organizational costs low. One of the best ways to do so is to guide members to the right kind of care. With that, it's also crucial to help members avoid unnecessary care. It might be shocking, but over-treating patients is rather common in the U.S. healthcare system. Physicians and hospitals have incentives to complete as many surgeries or procedures as possible, even when they're not needed. Unnecessary scans, screenings, and tests cost the American healthcare system millions every year. In fact, studies have shown billions of dollars each year go to unnecessary procedures, surgeries, and imaging.

By the numbers. 

  • According to the National Academy of Medicine, about $765 billion goes to waste every year. That's one-fourth of all the money spent in the American healthcare system.  
  • Approximately 85 percent of lab tests to prep healthy patients for low-risk surgeries are not necessary. These tests waste about $86 million every year. 
  • Annual heart tests not needed for low-risk patients consumed $40 million.

What you can do to help members.

Health cost sharing organizations have an opportunity to take significant steps to simplify their members' health. Your organization can guide members to make smarter healthcare choices that result in lower costs.

One of your first and easiest options to help members is to educate them on how to get second opinions. Second opinions can help cut unnecessary procedures and treatments. Another option is to recommend doctors who endorse other options first. Lifestyle changes or physical therapy can often be used first to avoid unnecessary surgery. It’s also helpful to encourage patients to research anything they are prescribed to ensure it is beneficial to them.

The next hurdle to overcome is members' apprehension about researching complex healthcare information. As a health cost sharing organization, you can reduce this fear and confusion. A good option is to partner with a patient advocacy company that offers members healthcare navigation. This gives members a dedicated patient advocate who cares about them and their needs. More hands-on members can try easy-to-use technology to shop and compare thousands of healthcare services.

Final thoughts.

Sometimes surgery is the only solution to fix a problem. But, there are also several medical situations where surgery should be a last resort. "The power of the lab coat," can sway members to receive expensive, invasive care they don’t need. As a health cost sharing organization, you can provide your members with reliable resources and patient advocates to guide their healthcare. And the good news is that when members receive affordable, quality care it helps you too by keeping sharing costs low. With healthcare navigation solutions, you can reach your goals of keeping costs low while making sure members are happy and healthy.

Download The Patient Advocacy 2.0 White Paper

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Download the Complete Guide to Growing Your Health Plan Membership

Learn the best strategies and tips for growing your members while keeping costs low.

Download the Complete Guide to Retaining Health Plan Members.

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